Healthcare Provider Details

I. General information

NPI: 1144475955
Provider Name (Legal Business Name): MS. NANCY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 08/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 COUNTY RD
NEW LONDON NH
03257-5736
US

IV. Provider business mailing address

249 COUNTY RD
NEW LONDON NH
03257-5795
US

V. Phone/Fax

Practice location:
  • Phone: 603-526-5544
  • Fax:
Mailing address:
  • Phone: 603-526-2911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: